LTHT Adherence to BSR Guidelines in the Diagnosis and Management of Giant Cell Arteritis: Benchmarking to a National Audit

Abstract

Background: Giant Cell arteritis (GCA) is a large-vessel vasculitis (LVV) affecting older adults and can lead to irreversible vision loss, stroke and aortic complications, making it a medical emergency. British Society for Rheumatology (BSR) NICE- accredited guidelines outline standards for urgent steroid initiation, fast track referral, specialist review and confirmatory investigations.

Aims: The National Early Inflammatory Arthritis Audit (NEIAA) evaluates adherence to BSR guidelines for GCA diagnosis and management across England and Wales. Key indicators include time to steroid initiation, access to imaging and temporal artery biopsy, fast-track GCA pathway use and time to rheumatology review.

Methods: A retrospective audit was conducted at LTHT (April - December 2025). Patients with newly diagnosed GCA or LVV were included. Exclusion criteria were incomplete time-stamp data, national data opt-out and GCA relapse. Data were extracted from electronic health records (PPM+), including admission documentation, medication records and referral correspondence. Descriptive statistics (percentages, medians and interquartile ranges) were used. The primary outcome was time from presentation to steroid initiation; secondary outcomes were imaging, temporal artery biopsy, fast-track pathway utilisation and time to rheumatology review. Performance was benchmarked against BSR standards.

Results: Of 75 patients identified via ultrasound records,17 (22.7%) had confirmed new-onset GCA and were included. Steroids were initiated on the day of referral in 50% of patients and by the following day in 75%, with 15% receiving steroids prior to referral (median 0 days, IQR 0-1 days). Fast-track pathways were used in 80% of cases; the remainder were inpatient referrals.

Conclusion: LTHT, averaging two new GCA diagnoses per month, demonstrates good adherence to national GCA management standards. Delays were infrequent and reflect inter-hospital transfer or imaging access issues. These findings will inform strategies to reduce preventable morbidity associated with delayed GCA diagnosis and treatment.